PubMed Health⌕ Search

Biomedical subjects

J Heptonstall

Publications and source records attributed to J Heptonstall.

At least 37 records · Page 2Linked to original sources
PubMed1995

How many people in England and Wales risk infection from injecting drug use?

Injecting drug users who share equipment may transmit and acquire bloodborne virus infections, including HIV, hepatitis B virus, and hepatitis C virus. Even without sharing, injection with non-sterile equipment, drugs, or mixing agents may result in infection due to bacteria or fungi. Estimates of the number of people who are currently at risk of infection from injecting drug use are needed in order to plan services and care, and to interpret surveillance data. This paper examines the data from registries of drug use and two recent surveys of the general population from which estimates of the number of current injecting drug users in England and Wales have been derived. Drug registries include only those whose drug use is identified during contact with drug or medical services, so these sources provide minimum estimates but may be used to monitor trends: 25,706 drug users in England and Wales were notified to the Home Office in 1993, 12,253 of whom were current injectors. Estimates derived from surveys of the general population suggest, however, that between 51,900 (95% confidence interval (CI): 33,000-71,600) and 77,700 (95% CI: 4100-151,200) people in England and Wales are at risk of infection from current injecting drug use, of whom between 10,400 (95% CI: 7200-13,800) and 15,500 (95% CI: 800-30,200) are at risk of bloodborne virus infections as a result of sharing injecting equipment. In the 16 to 34 year age group about one in 200 men, and one in 400 to 500 women may be current injectors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Outcome of an exercise to notify patients treated by an obstetrician/gynaecologist infected with HIV-1.

Experience with hepatitis B suggests that the risk of HIV transmission from a health care worker infected with HIV to a patient will be greatest during major surgical procedures. The number of patients worldwide who are known to have undergone such procedures, been notified, and subsequently tested is still too small to be confident that the risk of HIV transmission in these circumstances is negligible. We describe a patient notification exercise, undertaken in the United Kingdom in 1991. Attempts were made to contact 1217 patients, in three health districts (A, B, and C), who had undergone surgical procedures performed by an obstetrician/gynaecologist who was infected with HIV. The exercise aimed to offer the patients reassurance, counselling and--if they wished--HIV testing. One thousand one hundred and forty-two patients (94%) were contacted, and all 520 who elected to be tested were negative for anti-HIV. The proportion of identified patients tested was 63% in district A, 35% in district B, and 61% in district C. Surgical procedures were classified retrospectively according to the likely risk (none, possible, or high) of exposure to the doctor's blood and, therefore, risk of HIV transmission. One hundred and ninety-five of those tested had undergone a procedure that carried a high risk of exposure; 179 had undergone a procedure thought to carry no risk. Patients in districts A and C who had undergone a procedure that carried a high risk of exposure were more likely to be tested than those who had not; 206 patients overall had undergone procedures that carried a high risk of exposure but were not subsequently tested.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS Serodiagnosis↗
PubMed1994

Survey of human immunodeficiency virus infection among pregnant women in England and Wales: 1990-93.

We report on the first four years (1990-93) of a survey within the national HIV prevalence monitoring programme. The survey's objective is to monitor the prevalence of infection with the human immunodeficiency virus (HIV) in pregnant women in London and elsewhere in England. The survey--based in forty centres that offer antenatal care in London, Greater Manchester, West Yorkshire, and adjacent non-metropolitan areas--uses repeated cross sectional serosurveillance for anti-HIV-1 and 2 and the unlinked anonymous test method on blood left over from specimens collected for antenatal screening for immunity to rubella. The seroprevalence of HIV-1 ranged from 0.007% (1 in 14,530) in non-metropolitan areas, to 0.011% (1 in 8790) in metropolitan areas outside London, and 0.23% (1 in 440) in London. Evidence of HIV-2 infection was found in only four specimens, in London (1 in 50,300). The seroprevalence of HIV-1 in London varied more than tenfold between centres, from 0.03% (1 in 3190) to 0.51% (1 in 200). The highest prevalence of infection was in London in women aged between 20 and 30 (0.30%; 1 in 335). The seroprevalence in London centres rose from 0.18% in 1990 (1 in 560) to 0.26% in 1993 (1 in 390) and the rise was significant in all age groups. If voluntary confidential HIV testing (with counselling) among pregnant women in England were to be promoted, its cost effectiveness would be greater if focused on particular centres that provide antenatal care in London.

Adult↗
PubMed1994

Hepatitis B outbreak in a drug trials unit: investigation and recommendations.

In autumn 1990 three young men developed acute hepatitis B. They belonged to a group of 24 young male volunteers who had taken part in a trial in a residential unit for drug trials in July and August 1990. A further case of acute hepatitis B and a carrier of hepatitis B e antigen (HBeAg) were detected by serological testing of the volunteers. Volunteers, in two groups of twelve, had occupied the unit at different times during the trial. The four cases occurred in the group that contained the HBeAg positive carrier. The carrier had also taken part in two trials on the unit in 1989. He was HBeAg positive then, but transmission of hepatitis B virus (HBV) did not occur. Although blood samples were taken in each of the three trials, intravenous cannulas were used only in the 1990 trial. It is likely that HBV was transmitted by blood to blood contact between volunteers when blood was sampled through cannulas during the trial. This outbreak might have been prevented. If an infection control policy had been applied to avoid hazardous practices, and volunteers had been screened for HBV before entry and the carrier excluded (as recommended by the Association of Independent Clinical Research Contractors), the outbreak would not have occurred. Volunteers for drug trials in residential units should be screened for HBV, human immune deficiency virus (HIV) and hepatitis C virus (HCV), and those found to be infected should not be accepted.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1994

Hepatitis B immunization in UK renal units: failure to put policy into practice.

A postal questionnaire survey of renal units, and an analytical study of surveillance data on acute hepatitis B were undertaken to discover the numbers of renal units (a) routinely immunizing staff and patients against hepatitis B and (b) with recent experience of managing patients with hepatitis B. Seventy-three (86%) of 85 units returned completed questionnaires. Most (63, 84%) of the responding units routinely immunized staff but only 4 (5%) routinely immunized patients. A third (25) of the units had treated at least one HBsAg-positive patient between 1987 and 1991, and 11 units had cared for at least one patient with acute hepatitis B. Units with recent experience of treating an HBsAg-positive patient were no more likely to immunize staff or patients than those without. Guidance on hepatitis B immunization of staff has generally been implemented by UK renal units; that on immunization of patients has not. Renal unit patients remain largely susceptible to hepatitis B and the potential for outbreaks remains. Renal units need further encouragement to implement fully guidance on immunization.

Health Policy↗
PubMed1993

Health care workers and HIV: surveillance of occupationally acquired infection in the United Kingdom.

In the period 1985-1992, 176 significant occupational exposures to HIV were reported to the PHLS Communicable Disease Surveillance Centre. The outcome at three months post exposure was reported for 134 (76%) incidents. Ninety-nine of these involved percutaneous exposure to HIV-infected blood or serum; two resulted in seroconversion, one following the use of zidovudine post exposure. Under-reporting of significant exposures may have been considerable. However, the observed transmission rate, of 2%, is not inconsistent with other estimates. Two other documented seroconversions after occupational exposure have been reported, making a total of four health care workers known to have acquired HIV infection after occupational exposure in the UK. Another six UK health care workers have possible occupationally acquired HIV infections. Five of these probably became infected while working in adverse conditions in Africa; the other while working with HIV-infected patients in the United States and Europe. A summary of current good practice of post exposure management is provided. Practitioners providing post exposure care are asked to contribute to the national surveillance scheme. Initial reporting of significant occupational exposures, and of serological outcome at a minimum of six months post exposure, should be regarded as integral to satisfactory post exposure management.

Blood-Borne Pathogens↗
PubMed1993

Sexually transmitted diseases and HIV-1 infection among homosexual men in England and Wales.

OBJECTIVE: To examine surveillance data for evidence of changing sexual behaviour and continuing transmission of HIV-1 among men who have sex with men. DESIGN: Analytic study of surveillance data on sexually transmitted diseases. SETTING: England and Wales. MAIN OUTCOME MEASURES: Number of cases of rectal gonorrhoea and newly diagnosed HIV infection in homosexual men. RESULTS: New cases of gonorrhoea among men attending genitourinary medicine clinics increased by 7.7% in 1989 and by 4.2% in 1990. Reports of rectal isolates of Neisseria gonorrhoeae also rose and the male to female ratio for patients with rectal gonorrhoea changed from 0.3:1 during 1988-9 to 2.6:1 in 1990-1. Although the overall number of cases of acute hepatitis B fell during 1988-91, 81 and 82 homosexual men were infected in 1990 and 1991 respectively compared with 50 and 42 in 1988 and 1989. 1526 men had HIV-1 infection diagnosed in 1991, the largest number since 1987. Twenty eight of the 97 (29%) men who seroconverted between January 1989 and December 1991 were aged less than 25. The proportion of men aged 15-19 who were found to be infected with HIV-1 at their first test increased from an average of 2.4% up to 1990 to 4.7% in the first nine months of 1991. The prevalence of HIV infection in men under 25 attending genitourinary medicine clinics in London was 17% compared with 7.8% outside London. CONCLUSION: Unsafe sexual behaviour and HIV transmissions have increased among homosexual men after a period of decline. Recent HIV transmissions may disproportionately affect younger men.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The epidemiology and control of hepatitis A.

Hepatitis A virus (HAV) infection is endemic in developing countries and remains a public health problem elsewhere. A total of 7430 cases was notified in England and Wales in 1991. Children and young adults were most frequently affected. Risk factors include travel to countries of high endemicity, contact with an infected person and shellfish consumption. Person-to-person spread is common within families, closely knit communities and schools (especially nurseries). The provision of safe water and sanitary disposal of faeces are prerequisites for control of HAV throughout the world. In developed countries, human normal immunoglobulin (HNIG) is used for post-exposure prophylaxis and is given to those travelling abroad prior to possible exposure. Recommendations for the use of hepatitis A vaccine have have recently been made but it is expensive. Further studies on risk factors for infection, and on the efficacy of hepatitis A vaccine in outbreak control, are needed.

Adolescent↗